Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study
Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study
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DOI：
10.1016/s2468-2667(20)30010-4
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发表时间：
2020-04-01
影响因子：
50
通讯作者：
Canfell, Karen
中科院分区：
文献类型：
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作者：
Simms, Kate T.;Hanley, Sharon J. B.;Canfell, Karen
背景日本从2010年开始为12-16岁的女孩提供人乳头状瘤病毒(HPV)疫苗接种资金，最初三剂疫苗覆盖率达到70%以上。2013年6月14日，也就是日本国家疫苗接种计划正式启动两个月后，由于有报道称不良事件与疫苗接种无关，但媒体对此进行了广泛报道，因此暂停了对HPV疫苗的积极推荐。疫苗接种率随后下降到不到1%，到目前为止一直保持在这一低水平。我们的目标是量化疫苗迟疑危机的影响，以及如果能够恢复覆盖范围可能带来的健康收益。方法在此建模研究中，我们使用了Policyl-Cervior建模平台。我们通过使用有关HPV流行率、筛查做法和覆盖率以及宫颈癌发病率和死亡率的数据，使该模型适用于日本。我们在疫苗迟疑危机的背景下，评估了1994年至2007年出生的队列中宫颈癌病例和死亡的预期数量。我们评估了从2020年起的一系列复苏情景，包括常规覆盖率恢复到70%，错过的队列(2020年为13-20岁)的追赶覆盖率为50%的情景。为了估计到目前为止疫苗危机的影响，我们还模拟了一个反事实情景，从2013年起，疫苗危机在12岁儿童中保持了70%的覆盖率。研究发现，2013年至2019年的疫苗危机预计将导致1994年至2007年出生的队列的生命周期内额外增加24600-27300例病例和5000-5700例死亡，而如果自2013年以来覆盖率保持在70%左右。然而，在2020年恢复覆盖范围，包括对错过的队列进行补种接种，可防止14800-16200例此类病例和3,000-3,400例死亡。如果2020年不恢复覆盖，仅在2020年，就会在12岁的人的一生中额外发生3400-3800例病例和700-800例死亡。如果这场危机持续下去，在未来50年(2020年至1969年)，将有9300-10800人死于宫颈癌。据了解，到目前为止，日本人乳头瘤病毒疫苗危机估计导致约5,000人死于宫颈癌。如果能够迅速恢复扩大的疫苗接种覆盖率，这些死亡中的许多人仍然可以预防。版权所有(C)2020作者(S)。由Elsevier Ltd出版。这是一篇CC BY-NC-ND 4.0许可证下的开放获取文章。
Background Funding for human papillomavirus (HPV) vaccination in japan began in 2010 for girls aged 12-16 years, with three-dose coverage initially reaching more than 70%. On June 14, 2013, 2 months after formal indusion in Japan's national immunisation programme, proactive recommendations for the HPV vaccine were suspended following reports of adverse events since found to be unrelated to vaccination, but which were extensively covered in the media. Vaccine coverage subsequently dropped to less than 1% and has remained this low to date. We aimed to quantify the impact of this vaccine hesitancy crisis, and the potential health gains if coverage can be restored.Methods In this modelling study, we used the Policyl-Cervix modelling platform. We adapted the model for Japan with use of data on HPV prevalence, screening practices and coverage, and cervical cancer incidence and mortality. We evaluated the expected number of cervical cancer cases and deaths over the lifetime of cohorts born from 1994 to 2007 in the context of the vaccine hesitancy crisis. We assessed a range of recovery scenarios from 2020 onwards, including a scenario in which routine coverage is restored to 70%, with 50% catch-up coverage for the missed cohorts (aged 13-20 years in 2020). To estimate the impact of the vaccine crisis to date, we also modelled a counterfactual scenario in which 70% coverage had been maintained in 12-year-olds from 2013 onwards.Findings The vaccine crisis from 2013 to 2019 is predicted to result in an additional 24 600-27 300 cases and 5000-5700 deaths over the lifetime of cohorts born between 1994 and 2007, compared with if coverage had remained at around 70% since 2013. However, restoration of coverage in 2020, including catch-up vaccination for missed cohorts, could prevent 14800-16 200 of these cases and 3000-3400 of these deaths. If coverage is not restored in 2020, an additional 3400-3800 cases and 700-800 deaths will occur over the lifetime of individuals who are 12 years old in 2020 alone. If the crisis continues, 9300-10800 preventable deaths due to cervical cancer will occur in the next 50 years (2020-69).Interpretation The HPV vaccine crisis to date is estimated to result in around 5000 deaths from cervical cancer in Japan. Many of these deaths could still be prevented if vaccination coverage with extended catch-up can be rapidly restored. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.